Two similar Community Health Club (CHC) interventions to achieve hygiene behaviour change and improved family health in Africa took place—one in Zimbabwe implemented by an NGO and the other in Rwanda as part of a Randomized Control Trial. Both interventions achieved high levels of community response, although the Zimbabwe project was more cost-effective, achieving blanket coverage of all households in the area with over 90% compliance in 12 recommended practices at a cost of US$4.5 per beneficiary in 8 months. In Rwanda, the spread of the intervention reached only 58% of the households in the first year costing US$13.13 per beneficiary. By the end of three years, the spread had increased to 80% with over 80% of the 4056CHC Members adopting 10 new practices without any extra cost to the project. Although the Zimbabwe program showed better Value for Money, being more efficient, long term sustainability to prevent slippage of hygiene behaviour change depends on a strong monitoring system. Scaling up hygiene behaviour change is best achieved systematically by building the capacity of the Environmental Health Department to take responsibility for the supervision of CHCs in every village. Investing in an integrated national program, which can enable Government to coordinate NGO efforts, is a more cost-effective use of scarce resources in the long term.
Part of the book: Healthcare Access
The Community Health Club (CHC) Model in Makoni District, Zimbabwe operated 265 CHCs with 11,600 members from 1999 to 2001 at a cost of US$0.63 per beneficiary per annum. A decade later, 48 CHCs were started in three districts in Vietnam with 2,929 members at a cost of US$1.30. Hygiene behaviour change was compared using a similar survey of observable proxy indicators in both projects, before and after intervention. In Vietnam there was a mean of 36% change in 16 observable proxy indicators (p > 0.001) which compared positively with Makoni where there was a mean of 23% hygiene change in 10 indicators (p > 0.001). In Vietnam, 8 Health Centers reported a reduction of 117 cases of diarrhoeal diseases in CHC communes, compared to only 24 in non-CHC communes in one year; in 8 Health Centers in Makoni, Zimbabwe, a reduction of 1,219 reported cases over a 2–9 year period was reported, demonstrating the efficacy of CHC both in African and Asian context. We suggest that regular government data of reported cases at clinics may be a more reliable method than self-reported diarrhoea by carers in clustered-Randomised Control Trials, which have surprised practitioners by finding negligible impact of WASH interventions on diarrhoea in rural communities.
Part of the book: Rural Health